th Last semester section Home by mikeholy

VIEWS: 38 PAGES: 16

									MEASLES (RUBEOLA)
DEFINITION
   Measles is a communicable disease
    manifesting with fever , cough ,
    coryza , lacrimation and koplik spots
    in the pre – eruptive phase and a
    maculopapular rash starting at 4th or      Koplik spots
    5th day of the illness.
   Coryza : profuse discharge from the
    mucous membrane of the nose
    koplik spot : small, white spots (often
    on a reddened background) that
    occur on the inside of the cheeks
    early in the course of measles.
                                                   Coryza
ECOLOGICAL TRIAD
    Agent: Measles( paramyxovirus ,RNA virus)
    Age: children (6months -3 years)
    Measles tend to be very serious in malnourished
     children, mortality is 400 times higher.
      Both sexes are affected
    Immunity : -
     one attack of measles gives immunity for life.
      Infants acquire immunity transplacentally from mothers
      who have had measles or measles immunization. This
      immunity is usually completed for the first 4–6 months of
      life.
    Reservoir : - Man is only the reservoir of infection.
ENVIRONMENT
 Incidence is higher in spring and winter
 Incidence is higher in densely populated
  urban areas
Natural history
 Reservoir is a case of measles
 Source of infection: nasopharyngeal
  secretions, lacrimal secretion, urine
 Infectious period: 4 days before, and 5 days
  after the onset of rash
MODE OF TRANSMISSION
  Directly from person to person by droplet
   infection, droplet nuclei
  Other modes –fomites, airborne
 Incubation period: 8 – 12 days
PATHOGENESIS
        Virus infects by invasive of respiratory tract .
        After entering the viral particles infects the respiratory epithelium and
         local multiplication leads to primary viremia ( day 2 – 3 ) and
         subsequently spread to the reticuloendothelial system.
        Cells of reticuloendothelial system necrose , causing secondary
         viremia ( day 5 – 7 ) which is responsible for systemic symptoms.
        Multinucleated gaint cells can be demonstrated in both epidermis and
         oral epithelium by 7 – 11 days
   Two types of gaint cell are seen : -
      Warthin – Finkeledy cells of reticuloendothelial system
      Epithelium gaint cells of respiratory tract
   During infection , CD4T and CD8 cells are activated and
    participate in clearance of virus and development of rash.
    During recovery,level of interleukin 4 is elevated
   IL-4: protein that stimulates the immune system to develop mast cells,
    resting T-cells, and activated B-cells.
CLINICAL FEATURES
A.   Prodromal :
       - onset is acute with moderate elevation
     of temperature , cough , running of nose ,
     sneezing , redness of eyes and excessive
     lacrimation
     - on second or third day : koplik spots
     appear on the inner side of the cheek,
     opposite to the second molars .
     - Koplik spots increase in number for 2 to
     3 days and disappear by the end of
     second day of the rash
   Koplik’s spot:
Eruptive phase :
   With the appearance of rash on the 4th day the fever
    tends to rise again
   Early rash is erythematous and blanches on pressure (
    blotchy )
   First appears behind the ears , near the hair line on the
    forehead , face and neck and spread to trunk ,
    extremities , palms and soles within 3 days.
   The rash now appears brownish , and does not fade on
    pressure.
   Rash start disappearing after 4 to 5 days in the same
    order in which it appeared
   Fever and rash lasts for about a week in uncomplicated
    cases
   May complain anorexia , malasie , generalised
    lymphadenopathy
   Maculo-papular rash:
DIAGNOSIS
  Clinical diagnosis:
  Laboratory diagnosis:
  Blood count – leucocytosis in early stages
   followed by increased lymphocytes
  Sputum or urine culture
  Serological tests
 Complement fixation test
 Haemagglutination test
  Enzyme-linked immunosorbent assay (ELISA)
Differential diagnosis
 Rubella : rash is pink , maculopapular and
  discrete
 Infectious mononucleosis : rash is associated
  with generalised lymphadenopathy and
  hepatosplenomegaly
 Meningococcemia : rash appears within 24
  hours. Fever , vomiting , irritability and
  possibly stiff neck are present
 Drug rash : H / o drugs administration
 Sunburn
 Roseola infantum : - faint pink maculopapular
  rash.
Treatment :
   It is a self limiting disease unless it is
    complicated
   Symptomatic and supportive
   Body and oral hygiene are attended to
   Parents are encouraged to give bath to the child
    and mouth is washed and teeth are brushed
    daily
   Adequate amount of fluids orally
   Fever (paracetamol and hydrotherapy )
   Severe cough ( saline nebulization )
   Vitamin A decrease the severity , complication
    rate and mortality. Dose : 2 lac units , orally
    children older than one year of age for 2
    consecutive days.
PREVENTION AND CONTROL
 Control measures
 Isolation
 Bed rest
 Supportive Tx- vit. A ,
 Immunization of contacts within 2 days of
  exposure
 Preventive measures
 Active immunization(9 months,
  0.5cc,IM/SC,deltoid)
 Passive immunization (Human gamma
  globuline0.25ml/kg IM within 5 days of exposure)
VACCINES
  Dose and schedule:
 0.5ml – S/C – 9months
  Adverse reactions:
 Measles like illness, febrile convulsion, toxic
   shock syndrome, transient thrombocytopenia
  Contraindications: acute illness, untreated
   malignant diseases, immunodeficiency,
   pregnancy, received any live vaccine within 3
   weeks
COMPLICATIONS
     Respiratory tract :
       otitis
             media , cervical lymphadenopathy ,
        laryngitis , laryngotracheitis , interstitial
        pneumonia ,bronchopneumonia
   Encephalitis
   Digestive system :
       Persistent  diarrhea , appendicitis ( lymphoid
       tissue blocking the lumen of appendix ) ,
       hepatitis , ileocolitis
      Malnutrition : PEM
      Others : acute glomerulonephritis ,
       disseminated intravascular coagulation .

								
To top